Bronchoscopy is a test to view the airways and diagnose lung disease. Currently, a device called a flexible bronchoscope is most often used to see the inside of the airways and lungs. The flexible bronchoscope comprises a thin insertion tube from 2.2 to 6 mm or larger in diameter and about 2 feet long. The insertion tube is desirably minimized in diameter to reduce patient distress. The insertion tube is typically inserted at a free end into a patient mouth, into an airway, and then into the lung. The delicate, vascularized tissues of these airways requires an insertion tube which is minimally rigid, maximally flexible and relatively delicate as to its optical elements to accomplish insertion and desired placement of the free end without injury. Thus, it is well known that the flexible bronchoscope is especially prone to damage to its insertion tube section when not in patient use.
FIG. 14 shows a prior art flexible bronchoscope 10 illustrating its major parts. The flexible bronchoscope 10 generally comprises an insertion tube 11 (with a free, insertion end), a flared transition 12 to a junction housing 13 (which usually includes an articulation lever 14), and an eyepiece 15. It is well known to extend from the junction housing additional connections for wires or fiberoptic strands so that light and/or signals (light or electrical) may be transmitted thereon to a camera, a video recorder, or a display screen that displays a view from the insertion end of the bronchoscope 10. FIG. 14 shows the typical orientation of the bronchoscope 10 during storage and transportation from storage to use. A user will often grasp the structures above the insertion tube 11 and allow the insertion tube to dangle freely, making it an easy target for impact with other more durable structures, devices or personnel. Even slight impact can have a devastating effect on the sensitive optical and electrical features of the flexible insertion tube 11. In the case of a fiberoptic bronchoscope, terminal ends of fiberoptic strands may be broken or abraded or scored or such strands might be broken within the insertion tube. In the case of a CCD-tipped flexible bronchoscope, the highly sensitive CCD chip located at the terminal end of the insertion tube may receive an impact which entirely or partly destroys its operation or fine electrical connections to more substantial wires.
Flexible bronchoscopes are very delicate instruments that require special care at all stages of handling to prevent equipment damage. Even the control levers (such as the articulation lever 14 of FIG. 14) can easily be damaged during storage, transportation, cleaning and use. It is well known that bronchoscopy carts adapted to be mobile, wheeled carts contain typically used bronchoscopy supplies and equipment and comprise rigid tubes permanently fixed to the cart sides. These rigid tubes receive the insertion tubes of flexible bronchoscopes and support the upper structure of the bronchoscopes by way of contact of an upper rim of the rigid tube with a portion of the flared transition 12. Thus, the prior art teaches that adequate protection for flexible bronchoscopes is achieved by way of locating the insertion tubes in the rigid tubes of the bronchoscope cart. The prior art has clearly failed to appreciate that this solution has not been adequate. The clinical storage, transportation, cleaning and storage of flexible bronchoscopes is far broader in scope than a brief transportation of the device in a bronchoscopy cart.
First, storage of flexible bronchoscopes between uses is accomplished in a metal cabinet with elevated pairs of hooks adapted to engage the flared transition 12 to allow the insertion tube to dangle freely within the cabinet, open to becoming tangled with other insertion tubes, impact from personnel activity within the cabinet, or impact when the bronchoscope is put into or taken out of the cabinet. The present inventors have discovered that flexible bronchoscopes are often damaged in the cabinets or while being transferred from the cabinet to the cart or vice versa.
Second, after use in a bronchoscope procedure, best practices dictate that bronchoscopes are not returned to the rigid tube of the bronchoscopy cart, but instead are place in a disposable tray so that patient fluids adhering to the insertion tube are not transmitted to the inside surface of the rigid tube, which is difficult to disinfect and/or visualize for contamination. Placing the bronchoscope in such an exposed location exposes it to unintended impacts and abrasion from instruments, trays, and movement of items onto and away from the cart.
After exposure to harm on or around the bronchoscopy cart, the bronchoscope is transported to a decontamination suite in the open tray. This transportation allows further impacts and/or abrasion. Even slight, unappreciated impacts to the insertion tube or other elements of the bronchoscope can result in very substantial damage, as currently determined by the inventors.
In the past, bronchoscopy carts have incorporated cameras and display screens allowing for seeing the images available at the terminal end of the insertion tube, which coincided with the availability of rigid tubes in which to locally and temporarily store bronchoscopes. However, audio/visual integration and miniaturization of cameras and video processing and viewing equipment will result in a decline of bronchoscopy carts, as such image recording and display equipment is now typically a part of bronchoscopy procedure rooms. Without the need to transport the heavy or bulky image recording and display equipment, transport of bronchoscopes will eventually be made by way of withdrawal from the storage cabinet and carrying the bronchoscope, with an unprotected insertion tube, to the procedure room.
In modern state of the art hospitals facilities most operating rooms have built in video processors and displays, such that bronchoscopy carts are mostly obsolete. Thus, when requesting a bronchoscope, only the device is brought into the room (no cart with video equipment needed). Given that the rigid tube protector is built into the cart, the scope now arrives unprotected and typically placed in a plastic tray. This activity results in increased risk to the bronchoscopes over the methods in the recent past for transportation. One single university hospital O.R. department responsible for bronchoscopy on average spends $120,000 on annual bronchoscope repairs, the vast majority required due to equipment damage. Other endoscopic devices, such as transesophageal echo (TEE) probes, undergo a similar clinical usage regimen. Thus, there is a need for a storage and transportation device for bronchoscopes which reduces or eliminates potential harm to its impact sensitive components, while complying with industry infection control and safety standards.